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Women's Health Newsletters 11/14/99 - 12/26/99

 

 


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***** Woman's Diagnostic Cyber Newsletter *****
              November 14, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

2. Myths about breast feeding 
3. Reader submitted Q&A - HPV and Cancer
4. Endometrial cancer clearly explained
5. Vasectomy Answers
6. Humor is healthy


For those of you who use Netscape Navigator as 
your browser (not AOL users or Internet Explorer), 
and use My Netscape as your customizable home 
page, you can now add Woman's Diagnostic Cyber 
News, an abbreviated form of this newsletter, as a 
channel to your home page at My Netscape. 

To do this, just visit our home page:
Home page

and click on the Netscape banner "add this site to 
my Netscape" on the upper right page corner. 

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Myths about breast feeding
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women mean well in telling you their health 
stories, but breast feeding is a topic that seems 
to attract inaccurate information. Myths such as: 

Some women's breasts are too small for 
breast feeding. 

Breast feeding makes women gain weight. 

Women who go back to work or use child care cannot 
breast feed. 

Breast feedingg ties women down too much. 

Some women just run out of breast milk. 

Bottle feeding is just as good for babies as 
breast feeding. 
 
seem to spread around and cause women to give up 
breast feeding quickly. On the opposite side, 
sometimes the medical profession can make a woman 
feel guilty if she doesn't choose breast feeding.  
This site at Mayo Health has something to say 
about that also. 

Breastfeeding folk wisdom and facts

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - HPV and Cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I would like to know how accurate the tests are 
that are out right now for the different strains 
of HPV. I would like to have the test done if I 
thought it was reliable in diagnosing if I have 
the type(s) that is thought to lead to cervical 
cancer. I am very concerned about HPV and 
treatments and how from what I have heard that the 
treatments are not very successful. Do you know? 

There are two types of tests being used to 
identify different types of HPV, especially the 
high risk types for cervical cancer. One is to use 
the tissue from a Pap or biopsy and check for DNA 
fragments unique to HPV. The other test is one for 
antibodies to the viral capsule. With over 90 
different types of HPV it is difficult to say how 
accurate testing is. 

A large part of the answer to your question 
depends upon why you want to know the subtype and 
your understanding of what different treatment or 
action will be taken depending upon the results. 
For a discussion about HPV typeing tests, see: 

HPV Type Associated with Cancer

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Endometrial cancer clearly explained
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When the term - cancer of the uterus - is used, it 
can actually refer to either cervical cancer or to 
endometrial cancer. Pap smears screen for cancer 
of the cervix but they are not a screening test 
for endometrial cancer. Endometrial cancer peaks 
in the 55-65 age range and is often diagnosed by 
endometrial biopsy or D&C for abnormal uterine 
bleeding. 

The endometrium is the lining of the uterus that 
is sloughed each month with menses during 
reproductive years but then just remains 
constantly present in the menopausal years. 

One type of endometrial cancer is estrogen 
sensitive or dependent and is associated with 
conditions that elevate estrogen levels. These 
might include polycystic ovarian disease or any 
condition that causes irregular menses as well as 
taking estrogens supplements or prescriptions 
without taking additional progestin/progesterone 
to block the effect on the endometrium. 

The monograph below has a very good explanation of 
endometrial cancer with a minimum of medical 
jargon. It also explains about some of the 
hyperplasia categories that can sometimes precede 
invasive cancer. 

Endometrial cancer

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Vasectomy answers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sometimes a partner needs a little prodding, 
especially when it comes to having a sterilization 
procedure. You may even need to lead him to more 
information to counteract "locker room" myths. 

He will want to know if it affects erection or 
ejaculation (it doesn't) and if it causes any 
medical diseases (no it does not). Other questions 
such as "does it hurt?" and "how much does it 
cost?" are answered at this AVSC (Access to 
Voluntary and Safe Contraception) International 
site. 

Vasectomy answers

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
An old man goes to the doctor for his yearly 
physical, his wife tagging along. 

When the doctor enters the examination room, he 
tells the old man:   "I need a urine sample, a 
stool sample and a sperm sample." 
 
The old man, being hard-of-hearing, looks at his 
wife and yells:  

"What?  What did he say?  What's he want?"

His wife yells back, "He needs your underwear!" 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. 
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




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***** Woman's Diagnostic Cyber Newsletter *****
              November 21, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Food allergies
2. Estrogen in autoimmune diseases 
3. Reader submitted Q&A-What are natural hormones?
4. Postpartum blues, depression or psychosis?
5. Low blood sugar - multicausal, not a disease
6. Humor is healthy

For those of you who use Netscape Navigator as 
your browser (not AOL users or Internet Explorer), 
and use My Netscape as your customizable home 
page, you can now add Woman's Diagnostic Cyber 
News, an abbreviated form of this newsletter, as a 
channel to your home page at My Netscape. 

To do this, just visit our home page:
Home page

and click on the Netscape banner "add this site to 
my Netscape" on the upper right page corner. 

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Food allergies
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Symptoms of allergies to foods can include: 
vomiting, diarrhea, cramps, hives, swelling, a 
skin rash or itching. Sometimes the reaction can 
also cause a tightness in the throat, difficulty 
breathing, or wheezing. These can start within 
minutes or up to an hour after eating the 
causative food. 

Did you know that eight foods are the most common 
causes of over 90% of food allergies: milk, egg, 
wheat, peanut, soy, tree nuts, fish, and 
shellfish?  While almost 25% of people think they 
have a food allergy, in fact only about 1-2% of 
adults and up to 5% of children have legitimate 
food allergies. 

A big concern among people with food allergies is 
that packaged foods need to be labelled correctly 
because someone with a food allergy can die from a 
mislabelled package. At the Food Allergy Network, 
you can sign up for news alerts when, for example, 
"Tyson Foods recalls packages of "Restaurant 
Favorites" Chicken Breast Fajitas and Kirkwood 
Chicken Fajita Kits for containing undeclared 
milk." and "Swanson Frozen Foods recalls packages 
of Great Starts French Toast Sticks breakfasts for 
containing undeclared milk" 


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Estrogen in autoimmune diseases
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many autoimmune diseases tend to occur in higher 
frequency in women than men. For example, the 
female-to-male susceptibility ratio is 9:1 for 
systemic lupus erythematosus (SLE), 2:1 to 4:1 for 
rheumatoid arthritis (RA), and 9:1 for Sjogren's 
syndrome (SS). In thyroid disease, the female-to-
male ratio is over 25:1 for adult onset 
Hashimoto's thyroiditis and over 4:1 for Graves 
hyperthyroidism. Idiopathic adrenal insufficiency, 
scleroderma, myasthenia gravis and autoimmune 
diabetes mellitus also have from 2:1 to 5:1 
female-to-male risk prevalence ratios. 

Scientists theorize that women have exaggerated 
responses to autoantigens and that perhaps 
estrogens stimulate that "self-allergic" response 
and /or androgens (male hormones) suppress that 
response. It is not entirely clear, however, 
because estrogens seem to worsen SLE but they 
improve rheumatoid arthritis. 

The study below does not answer all these 
questions about hormones and immunity but points 
out that the T-cells, which are central to the 
immune response, are rich in cell receptors for 
estrogen. Also, estrogens can stimulate antibodies 
and androgens can suppress them. This may have 
some implications for the use of antiestrogens or 
androgens as treatment for autoimmune diseases in 
women. 

Estrogen in autoimmunity

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A-What are natural hormones?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There is quite a bit of confusion about natural 
hormones and estrogen replacement therapy. 
Depending upon what you consider "natural" and 
what attributes or advantages you think might be 
associated with "natural", will govern what 
supplements and what prescriptions you will seek 
out. 

Did you know that what most people consider as 
natural estrogens have no lower incidence of 
breast cancer or even other short term side 
effects than other estrogens? 

See our discussion at:

What is natural about natural hormones?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Postpartum blues, depression or psychosis?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mothers may be suprised about occasional negative 
thoughts they may have about a newborn baby. This 
can be a normal part of the postpartum blues. In 
about 10% of women, it can progress further into a 
severe postpartum depression. 

This may be manifest by constant fatigue, 
emotional numbness, withdrawal from others in the 
family, lack of concern for yourself or your baby, 
sleep difficulties, decreased libido, and a sense 
of failure and inadequacy. Women may even have too 
high expectations, and be over demanding, or feel 
trapped. If thoughts of hurting yourself or the 
baby creep up, it is time to seek help 
immediately. 

The Mayo Health site below also has a brief quiz 
assessment to see if you may already be depressed. 

Postpartum depression

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5.Low blood sugar - multicausal, not a disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hypoglycemia can be due to many different diseases 
and conditions. It produces symptoms of fatigue, 
dizziness, mood changes, anxiety, trembling hands, 
concentration/attention disorders, visual 
disturbances, memory problems, sleep difficulties, 
headaches, and sudden sweating among others. Two 
main types of chronic hypoglycemia are reactive 
hypoglycemia and fasting hypoglycemia. Reactive 
hypoglycemia often produces symptoms a couple of hours 
after a simple carbohydrate load (pie, cake, 
cookies, Coke). Fasting hypoglycemia produces 
symptoms early in the morning before breakfast. 

The abnormal physiologic condition is confirmed by 
an extended glucose tolerance test (4-6 hours) and 
then you need to make sure which of the many 
causes may play a role: heredity, if 
hypoglycemia or diabetes runs in the family; 
weakened immune system, e.g. after a (viral) 
infection; tumors, like an insulinoma; wrong 
eating habits, esp. sugar intake; prolonged use of 
refined food; prolonged use of drugs like 
antibiotics; hormonal disorders; chronic stress, 
bodily as well as mental; old infections, e.g. 
Pfeiffer disease; pancreas overload; excess 
physical exercise; food intolerance and allergies, 
e.g. celiac symptoms and hypoglycemia symptoms can 
be very look-alike, some people consider 
hypoglycemia as a side-effect of their allergy or 
intolerance. 

The nice part about this condition is that diet 
can control the symptoms. 

Hypoglycemia symptoms and causes

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
History Of Medicine

2000 B.C. - Here, eat this root.

1000 A.D. - That root is heathen.  Here, say this prayer.

1850 A.D. - That prayer is superstition.  Here, drink this potion.

1940 A.D. - That potion is snake oil.  Here, swallow this pill.

1985 A.D. - That pill is ineffective.  Here, take this antibiotic.

2000 A.D. - That antibiotic is artificial.  Here, eat this root.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. 
Pointing you in the right health direction.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





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***** Woman's Diagnostic Cyber Newsletter *****
              November 28, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Choices of oral contraceptives - if and what
2. Cancer of the cervix in older women 
3. Reader submitted Q&A - Fibroid treatments
4. Varicose veins
5. Your local area's water quality
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Choices of oral contraceptives - if and what
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women are choosing or being recommended to take 
oral contraceptive pills (OCPs) for more and more 
reasons lately. Perimenopausal women may use OCPs 
for stabilization of hormonal levels just before 
menopause to reduce intermittent menopausal-type 
symptoms. Women with abnormal uterine bleeding are 
often prescribed OCPs for several cycles or more 
to try to regulate the bleeding problem. Pills can 
also be effective for reducing PMS symptoms in 
many women and continuous OCPs (no 4th week break) 
are used for endometriosis treatment. 

Because so many women may end up taking OCPs for 
non contraceptive reasons, it is helpful to review 
the indications, contraindications and pros and 
cons of different OCP formulations. A recent 
comprehensive review article in American Family 
Physician has some very useful tables and tips. 

The article covers: 

different formulations of pills and their brand 
names, 
1) the non contraceptive benefits of oral 
contraceptive pills, 
2) the World Health Organization precautions for the 
use of oral contraceptive pills, 
3) the cardiovascular and thromboembolism risks of 
the pills 
4) factors to consider in starting or switching oral 
contraceptive pills 
5) side effects of pills
6) and potential interactions between oral 
contraceptive pills and selected drugs 

Also there are sections on special groups of women 
such as over 35, perimenopause, and adolescents 
and which are the better pills to choose for those 
groups of women. 

OCP risks, formulations and benefits review

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Cancer of the cervix in older women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
About one fourth of all cervical cancer occurs 
after age 65. That is reason enough to continue 
having Paps even after you think you don't want to 
have any more pelvic exams. Over 40% of the deaths 
from  cancer of the cervix occur after age 65 
probably because many women avoid continuing 
regular exams and Paps and the disease gets 
discovered at more advanced stages than it does 
with regular exams. 

Did you know that Medicare only pays for a Pap 
smear every 3 years? If you have had regular exams 
and no abnormal Paps, every three years for the 
Pap smear (not the physical and pelvic exam) is 
probably a reasonable cost-effective strategy. We 
know that more than half of women over 65 HAVE NOT 
had a Pap smear within 3 years. The moral of the 
story is that you cannot  forget and extend your 
Paps out to more than 3 years because that is how 
cancer becomes advanced before diagnosis. 

Many physicians are more cautious than current 
guidelines and would still recommend yearly Pap 
smears over age 65 if you have ever had an 
abnormal smear or a history of a human papilloma 
virus (HPV) infection. 

Another fact sheet you may be interested in about 
cancer of the cervix comes from the National 
Cancer Institute - What you need to know about 
cancer of the cervix. It describes: 

What Is Cancer?
Precancerous Conditions and Cancer of the Cervix
Early Detection
Symptoms
Diagnosis
Treating Precancerous Conditions
Treating Cancer of the Cervix
Staging
Getting a Second Opinion
Preparing for Treatment
Methods of Treatment
Clinical Trials
Side Effects of Treatment
Surgery
Radiation Therapy
Chemotherapy
Biological Therapy
Nutrition for Cancer Patients
Followup Care
Support for Cancer Patients

Cancer of the cervix fact sheets (NCI)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Fibroid treatments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have heard that there is a new technique for 
removing uterine fibroids by injecting something 
into the blood. Can you tell me something about 
this? I'm not interested in a hysterectomy ". 

Uterine fibroid embolization is probably the 
procedure you are talking about. It involves 
catheterization of the femoral arteries and 
injecting polyvinyl alcohol microspheres to block 
off the fibroid's blood supply. It can result in 
moderate pain for 4-7 days. Its not a totally 
benign procedure and needs to be compared to the 
other non hysterectomy treatments for fibroids 
such as: 

myomectomy
laparoscopic myomectomy
hysteroscopic fibroid resection
laparoscopic myolysis
fibroid embolization

These are briefly discussed at:

Non Hysterectomy Fibroid Treatments Including Embolization

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Varicose veins
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Varicose veins, those large blue bulging cords on 
the legs during pregnancy or those starburst 
spider veins on the skin surface occur much more 
commonly in women than in men. They also tend to 
run in families so if mother had a problem with 
varicose veins, you are more likely to have 
problems also. 

Other than wearing support hose and avoiding
prolonged standing, there is not much non surgical 
treatment that can be done for varicose veins. 
They get worse with age and many women submit to 
surgical vein stripping. Spider veins can be 
treated non surgically but they require injection 
of a medication that scars the vein shut. 
Treatment is usually a permanent disappearance of 
the veins unless a person is obese and predisposed 
to forming new varicosities. 

Varicose veins

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Your local area's water quality
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many of you recently may have received a report in 
the mail from your municipal water supply 
indicating what quantities of many different 
chemicals are present in your water supply. This 
report was the direct effect of a new Federal law 
requiring all city water municipalities to 
disclose a water quality report to each of its 
customers. If you are on well water you would not 
have received one of these. If you missed those 
reports, the Water Utility Home Pages may have the 
report for your city. 

City Water Utility reports

You may be interested in the large amounts of 
chemicals and pesticides that are applied to 
various places each year and may in some amounts 
make it into our water supply. Do you think 
bottled water is always purer than tap water? 
Sometimes it is not. 

Detailed water information

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Blondes always take the hits, but God Knows
-=-=-=-=-=-=-

Three blonde men are stranded on one side of a 
wide river, and don't  know how to get across. 

The first man prays to God to make him smart 
enough to figure out how to cross the river, so 
God turns him into a brown-haired man and he swims  
across. 

The second man prays to God to make him even 
smarter, so God turns him into a dark-haired man 
and he builds a boat and rows across. 

Then the third man prays to God to make him the 
smartest of all, 

so God turns him into a woman and he walks across 
the bridge. 

Contributed by: Andrea

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. 
Real world medical experience saves your time.

Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
              December 5, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Marine wound infections
2. Effective treatment of hypertension
3. Reader submitted Q&A - Taking Clomid®
4. High caffeine intake and miscarriages
5. Thick toenails
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Marine wound infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The sea and seashore can produce many unusual 
infections associated with diving, fishing, 
handling fish or seafood or even just cutting your 
foot on a seashell. These unusual infections can 
be from bacteria, mycobacterium, protozoa and 
viruses. Most inland doctors are not very aware of 
these organisms and the treatment needed. Skin 
infections and cellulitis are the main disorders 
you may acquire although eye, ear and even rarely 
meningitis types of infections can crop up. If you 
return from the beach or your Caribbeann vacation 
with a cut that looks red, you need to be careful 
if it looks like the infection is not quickly 
clearing. 

Among these unusual infectious agents are:

Vibrio vulnificus
Vibrio parahaemolyticus 
Erysipelothrix rhusiopathiae
Aeromonas hydrophilia 
Mycobacterium marinum 
Acanthamoeba
Pfiesteria piscicida
Giardia lamblia 
Endamoeba histolytica 
Hepatitis A virus

The following information at Diving Medicine 
Online is handy to have available if you are 
suspicious of a marine infection or spend a lot 
of time around the ocean or lakes. 


Bacterial infections and diving

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Effective treatment of hypertension 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did you know that less than a third of people with 
hypertension have their blood pressure under 
control? Its not because treatments are 
ineffective but rather due to how we comply with 
diet, weight loss and pill taking regimens. 

Low salt (sodium) diets seem to only decrease 
blood pressure by 4/1 mm of Hg. A diet rich in 
fruits and vegetables and low in total and 
saturated fats was found to lower the BP by 11.4 
mm Hg systolic and 5.5 mm Hg diastolic in 
hypertensive patients. Weight loss diets caused an 
average drop of 11/8 mm Hg while combination drug 
therapy (usually an antihypertensive medication 
combined with a diuretic) resulted in an average 
systolic to diastolic drop of 22/12 mm Hg. Also, 
dietary therapy only seemed have a short term 
effect on the blood pressure and within 5 years, 
most of the effects of dietary change disappeared 
even though patients still stuck to the diets. 

The moral of the story is taking medicine 
consistently is much more important than dietary 
change in controlling hypertension. This doesn't 
mean to throw the diet changes out; just be sure 
to take your medicine. 

The paper below from the Annals of Internal 
Medicine also suggests you are more likely to 
comply with taking your antihypertensive 
medications if: 

1) you had good education in the doctor's office 
about treatment when first starting medications 
2) a family member is enlisted to monitor your 
taking of medication 
3) you use a home blood pressure monitor and 
record measurements 
4) your regimen of medication is a once-daily 
dosage 
5) nurses reinforce your education at each 
doctor's office visit. 

Improving Treatment Effectiveness in Hypertension

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Taking Clomid®
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My doctor prescribed Clomid® and told me how to 
use it but I don't get my period every month. I 
have some birth control pills left. Should I use 
them so I can start the Clomid®?". K. 

Clomid® (clomiphene citrate) is a "fertility" pill 
used to induce ovulation in women with infrequent 
menstrual periods due to polycystic ovarian 
disease, hypothalamic anovulation and other 
situations associated with infertility. There are 
different regimens used in order to make the ovary 
ovulate. 

Usually a menses needs to be induced to make sure 
ovulation or pregnancy has not just occurred and 
to make sure the lining of the uterus is at the 
right phase to receive implantation of the egg. 
These instructions and others are discussed at the 
article below. 

Taking Clomid® for Ovulation 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. High caffeine intake and miscarriages
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Various studies using a history of how many 
caffeinated beverages are drunk each day have 
sometimes implicated high caffeine intake as a 
cause of spontaneous miscarriage. This study in 
the New England Journal of Medicine measured blood 
serum levels of paraxanthine, a caffeine 
metabolite, in women with normal pregnancy 
outcomes versus women whose pregnancies ended in 
miscarriage. They found that at high levels of 
caffeine there was a two fold risk of pregnancy 
loss. 

Although the abstract below does not indicate what 
caffeine level is safe, the full-text article in 
the Journal reasons indirectly that at less than 
the equivalent of 6 cups of coffee per day in a 
non-smoker and 11 cups of coffee a day in a smoker 
(smoking lowers serum caffeine levels) there was 
no increased risk. Therefore the intake of 
caffeinated beverages at the equivalent of more 
than 6 cups of coffee per day may increase the 
chance of miscarriage. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Thick toe nails
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thick toenails often represent a fungal infection 
called onychomycosis. It makes them brittle and 
either white or yellow in color. Moisture, tight 
fitting shoes and aging (because the toenail grows 
more slowly) are more likely to be associated with 
this fungal infection. It is fairly difficult to 
get rid of. Terbinafine (Lamisil(R)) is the 
medical treatment of choice but partial or 
complete nail removal may need to be done. It may 
take up to a year or so to see a complete cure 
just because toenail growth can take that long. 

Toenails infected with a fungus do not present a 
health hazard or problem. Mostly it is a cosmetic 
problem but also a flag that there may be 
underlying diabetes or vascular flow problems to 
the feet. More often than not, however it is due 
to lack of attention to the feet and to good 
fitting shoes. 

Thick toenails

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A big shot business man had to spend a couple of 
days in the hospital. He was a royal pain to the 
nurses because he bossed them around just like he 
did his employees. 

None of the hospital staff wanted to have anything 
to do with him. The head nurse was the only one 
who could stand up to him. She came into his room 
and announced, 

"I have to take your temperature." 

After complaining for several minutes, he finally 
settled down, crossed his arms and opened his 
mouth. 

"No, I'm sorry," the nurse stated, "but for this 
reading, I cannot use an oral thermometer." 

This started another round of complaining, but 
eventually he rolled over and bared his rear end. 

After feeling the nurse insert the thermometer, he 
heard her announce, "I have to get something. Now 
you stay JUST LIKE THAT until I get back!" 

She leaves the door to his room open on her way 
out. He curses under his breath as he hears people 
walking past his door laughing. After almost an 
hour, the man's doctor comes into the room. 

"What's going on here?" asked the doctor.

Angrily, the man answers, "What's the matter, Doc? 
Haven't you ever seen someone having their 
temperature taken?" 

After a pause, the doctor confesses, "Well. no. I 
guess I haven't. 
Not with a carnation anyway." 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. 
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
              December 12, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Chronic fatigue syndrome and fibromyalgia
2. Herpes management guidelines 
3. Reader submitted Q&A - Menstrual seizures
4. Atlas of skin diseases
5. Pregnancy resources brought together
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Chronic fatigue syndrome and fibromyalgia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
These two different, poorly diagnosed conditions 
both have muscle pain and fatigue as prominent 
symptoms. Sometimes doctors mislabel patients 
with one condition when their symptoms really fit 
the other better. 

Chronic fatigue syndrome is a difficult diagnosis 
to make. No laboratory tests are helpful. The 
diagnostic criteria include: 

The new occurrence of chronic or relapsing fatigue 
not associated with exertion and a 6 month history 
of 4 or more of the following concurrent symptoms: 

1) substantial short-term memory/concentration 
impairment 
2) sore throat 
3) tender lymph nodes
4) muscle pain 
5) multiple-joint pain without swelling or redness 
6) headaches of a new type, pattern, or severity
7) unrefreshing sleep and 
8) post-exercise fatigue lasting more than 24 
hours. 

Fibromyalgia has many of the same manifestations 
but the fatigue is due to sleep deprivation. The 
location of the muscle pain is very key to making 
a fibromyalgia diagnosis. 

Classification of Fibromyalgia

Basics of CFS and fibromyalgia

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Herpes management guidelines 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Association of Genito Urinary Medicine of the 
UK has published guidelines for many of the 
sexually transmitted diseases. Did you know that 
after the first symptomatic episode of genital 
herpes, there is an average of 4 recurrences a 
year? Genital herpes (HSV) is a condition that can 
have confusing treatment guidelines because the 
medicines used to treat outbreaks is not always 
effective and are relatively expensive in the 
doses and courses recommended. 

A close look at the treatment guidelines shows 
that the anti-herpes medicines of acyclovir, 
famcyclovir, and valacyclovir: 

---First episode of herpes ---

1) The medicines only lessen the symptoms by about 
one day. 
2) Creams (topical agents) are even less effective 
than pills and not of much use in the first herpes 
occurrence. 
3) Bathing in salt (saline) solution such as 
Artificial Sea from the local fish aquarium supply 
store and pain pills are effective supportive 
treatments 

---Recurrent genital herpes---

1) Women who have 6 or more recurrences a year 
experience a significant reduction (about 50%) in 
recurrences if they take daily anti-herpes 
treatment. 

2) Use of these medicines early in the prodromal 
phase of an outbreak aborts about 10% of outbreaks 
and shortens the symptoms by about 2 days. 

3) After a one year trial of suppression with anti-
viral meds, those medications should be 
discontinued to see if the recurrence rate has 
been permanently decreased. 

Herpes guidelines

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Menstrual seizures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am trying to find a birth control pill 
consisting of only natural progesterone, (not 
synthetic).  Is there such a thing? Also, would a 
natural progesterone pill (or the cremes for that 
matter), protect you against getting pregnant? 

I am 34 yrs old and suffer from endometriosis, and 
seizures.  I was put on the pill to help with the 
painful cramps, but the estrogen in these pills 
causes me to have seizures.  I have catamenial 
epilepsy, and am taking Neurontin(R) for it." 

Catamenial epilepsy refers to the worsening of 
seizure frequency during menses. Estrogen can 
worsen these seizures while progesterone can 
lessen them. Taking hormones for contraception or 
menopause can complicate the control of epileptic 
seizures. 

There are no natural progesterone contraceptives 
and progesterone creams will not protect against 
pregnancy. See the discussion of contraception and 
menstrual seizures. 

Menstrual Seizures and Progesterone

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Atlas of skin diseases
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Dermatology Online Atlas at the University of 
Erlangen, Germany, has quite a collection of skin 
lesions. It isn't set up to help you diagnose what 
a given skin condition might be, but if you want 
to look at examples of a known disease, you can 
see what they look like and the range of 
appearances. 

For example, if you think a skin rash might be  
psoriasis, you can look under the P's and see: 

Psoriasis Arthropathica 
Psoriasis inversa 
Psoriasis palmaris et plantaris 
Psoriasis palmoplantaris 
Psoriasis Pustulosa Generalisata 
Psoriasis Pustulosa Hypocalcaemica 
Psoriasis pustulosa palmaris et plantaris, Barber-
Konigsbeck Type 
Psoriasis Vulgaris 
Psoriasis Vulgaris, Chronic Stationary Type 
Psoriasis Vulgaris, Guttate Type
Psoriasis Vulgaris, Nail Changes 
Psoriatic Erythroderma 

Please don't use this resource to diagnose your 
own skin rash or those of friends. Rather use it 
to see the wide range of presentation of skin 
conditions and to learn all of the variations and 
possibilities for a given disease. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Pregnancy resources brought together
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yahoo.com has entered the health care arena in a 
fairly big way, other than just indexing sites, by 
gathering their own material and material from 
iVilliage.com and others to offer the pregnant mom 
a great place to find many related resources. 

There is a pregnancy calendar, drug safety lookup 
table, send a birth announcement, a baby's name 
list selector, baby shower registration and some 
frequently asked questions about pregnancy. You 
can even build a free web page on Yahoo's 
geocities.com for your new baby! 

Check out the "what to expect" section for answers 
to common questions that arise during pregnancy. 

Pregnancy support resources

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Just Like a Surgeon
 
Morris was removing some engine valves from a car 
on the lift when he spotted the famous heart 
surgeon Dr. Michael DeBakey, who was standing off 
to the side, waiting for the service manager. 
 
Morris, somewhat of a loud mouth, shouted across 
the garage, "Hey DeBakey! Is dat you? Come over 
here a minute." 
 
The famous surgeon, a bit surprised, walked over 
to where Morris was working on a car. Morris in a 
loud voice, all could hear, said argumentatively, 
"So Mr. Fancy Doctor, look at this work. I also 
take valves out, grind 'em, put in new parts, and 
when I finish this baby will purr like a kitten. 
So how come you get the big bucks, when you and me 
are doing basically the same work?" 
 
DeBakey was very embarrassed and as he walked 
away, said softly to Morris, 

"Try doing your work with the engine running." 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. 
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
              December 19, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Anti-perspirants NOT a cause of breast cancer
2. Gynecologic Endoscopic Atlas 
3. Reader submitted Q&A - Recurrence genital warts
4. Perimenopause
5. Risk factors for domestic violence
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Anti-perspirants NOT a cause of breast cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Rumor spreading now goes faster by email. One of 
the inaccurate rumors is about anti-perspirants 
being linked to breast cancer. Apparently, 
someone's concept of anti-perspirants is that it 
blocks toxins secreted by our bodies and those 
toxins can cause breast cancer. 

While they block some sweat from the underarm 
area, sweat is still secreted from many places on 
the skin such as hands, soles of feet and the back 
among others. The components of sweat such as 
salts or urea are not know to be cancer causing. 

Read about this email rumor at the Susan Komen 
breast cancer web site below.

Email antiperspirant rumor unfounded

If a close family member has breast cancer, they 
should be tested for the breast cancer genes - 
BRCA-1, BRCA-2. If they are negative, this is 
eliminated as a risk factor for you. If they are 
positive, you should be tested. There is a good 
collection of resources at Facingourrisk.org , a 
web site designed for those women who are BRCA 
positive or who have a strong family history of 
breast cancer. 

Facing our risk of cancer empowered - resources

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Gynecologic Endoscopic Atlas
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For those whose relate better to medical concepts 
when they can picture the disease process, you 
might want to view these images at the 
International Society for Gynecologic Endoscopy. 
There are quite a few laparoscopic and 
hysteroscopic images of: 

Fibroids
Endometriosis
Hysteroscopic Resection
Adhesions
Fimbrial Cyst
Normal View of Pelvis
Stomach and Liver
Appendix
Uterosacral Ligament

Gynecologic images

If you are having a laparoscopy, you may want to 
also look at some pages about what to expect when 
having a laparoscopy. 

Laparoscopy - What to Expect

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Recurrence genital warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I've been diagnosed with having HPV (genital 
warts). I've had them for over 2 years and since 
I've known I had them, I haven't had one day 
without them. No treatment seems to work. The 
cryosurgery works but as soon as they kill 5, 10 
more pop up. What can I do? Is there any way to 
stop this? Is there something I can do to help? 

Most warts of any type eventually go away. But the 
time  to clearing is years. It may take up to 5-10 
years in children for genital warts to disappear 
and probably less than that in adults. Most 
treatment is based upon destruction of the wart by 
various means but even after long courses of 
treatment the recurrence rate can be 20-40%. 

Immune stimulation therapy with a patient-applied 
cream currently seems to have the best cure rate 
and lowest recurrence rate. There are many factors 
affecting genital warts, however. For a discussion 
of these, see our article at: 

Recurrence of warts with different treatments

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Perimenopause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Perimenopause is a name given to those years 
preceding menopause when there may be some changes 
in the reproductive hormones and ovulation. 
Ovulation is a delicate mechanism that can be 
easily disrupted by stress, aging and many 
environmental factors. This disruption can produce 
symptoms, the most common of which are menstrual 
abnormalities. Woman may skip periods or they may 
have heavier and more frequent menses. Extra 
spotting is not uncommon. On symptoms alone, 
anatomical causes of bleeding can present 
similarly to perimenopausal bleeding so it is not 
safe to assume all bleeding has a hormonal cause. 

Breast tenderness becomes unpredictable and 
premenstrual irritability can also be worse or 
more unpredictable. Pregnancies and STDs are still 
possible so protection is needed against those.  
While hot flashes can occur before menopause, they 
are still relatively infrequent in occurrence. 
Sometimes vaginal dryness can also be a problem 
before full menopause. 

Be sure to ask your doctor for possible treatment 
for any of these perimenopausal symptoms if they 
are affecting your daily activities or causing 
concern. 

See the peimenopause brochure at the Association 
of Reproductive Health Professionals web site: 

Perimenopause

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Risk factors for domestic violence
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women are very much more at risk of being victims 
of physical domestic violence than are men. This 
New England Journal of Medicine study looked at 
what were the other risk factors among 256 women 
who suffered an acute injury from physical assault 
by a male partner. 

They found the major risk factors to be:

alcohol abuse
drug use
intermittent employment
recent unemployment
having less than a high school education
the partner being a former husband, estranged husband or 
former boyfriend

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A selection of carols for your dysfunctional 
friends: 

SCHIZOPHRENIA:
    Do you Hear What I Hear? 

MULTIPLE PERSONALITY DISORDER:
    We Three Queens Disoriented Are 

DEMENTIA:
    I Think I'll Be Home for Christmas 

NARCISSISTIC:
    Hark the Herald Angels Sing About Me 

MANIC: 
    Deck the Halls and Walls and House and Lawn and Streets and
    Stores and Office and Town and Cars and Busses and Trucks and 
    Trees and Fire Hydrants and.. 
    
PARANOID:
    Santa Claus is Coming to Get Me. 
   
PERSONALITY DISORDER: 
   You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, 
   Maybe I'll tell you Why. 
   
DEPRESSION: 
    Silent Anhedonia, Holy Anhedonia, All is Flat, 
    All is Lonely. 
  
OBSESSIVE-COMPULSIVE DISORDER: 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock,  
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock, 
    Jingle Bell, Jingle Bell, Jingle Bell Rock ........
    ....(better start again) 

PASSIVE-AGGRESSIVE PERSONALITY: 
    On the First Day of Christmas My True Love Gave to Me 
    (and then took it all away). 
  
BORDERLINE PERSONALITY DISORDER:
    Thoughts of Roasting on an Open Fire.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. 
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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